Trafford. Local system review report. Background and scope of the local system review. The review team. Health and wellbeing board

Size: px
Start display at page:

Download "Trafford. Local system review report. Background and scope of the local system review. The review team. Health and wellbeing board"

Transcription

1 Trafford Local system review report Health and wellbeing board Date of review: October 2017 Background and scope of the local system review This review has been carried out following a request from the Secretaries of State for Health and for Communities and Local Government to undertake a programme of 20 targeted reviews of local authority areas. The purpose of this review is to understand how people move through the health and social care system with a focus on the interfaces between services. This review has been carried out under Section 48 of the Health and Social Care Act This gives the Care Quality Commission (CQC) the ability to explore issues that are wider than the regulations that underpin our regular inspection activity. By exploring local area commissioning arrangements and how organisations are working together to develop person-centred, coordinated care for people who use services, their families and carers, we are able to understand people s experience of care across the local area, and how improvements can be made. This report is one of 20 local area reports produced as part of the local system reviews programme and will be followed by a national report for government that brings together key findings from across the 20 local system reviews. The review team Our review team was led by: Delivery Lead: Ann Ford, CQC Lead reviewer: Rebecca Gale, CQC The team included: Three CQC reviewers One CQC analysts Page 1

2 One Pharmacy Inspector Two CQC Inspectors One CQC Expert by Experience Four specialist advisors (two current Directors of Adult Social Services, one Clinical Commissioning Board member and a former National Director). How we carried out the review The local system review considered system performance along a number of pressure points on a typical pathway of care with a focus on older people aged over 65. We also focussed on the interface between social care, general medical practice, acute and community health services, and on delayed transfers of care from acute hospital settings. Using specially developed key lines of enquiry, we reviewed how the local system is functioning within and across three key areas: 1. Maintaining the wellbeing of a person in usual place of residence 2. Crisis management 3. Step down, return to usual place of residence and/ or admission to a new place of residence Across these three areas, detailed in the report, we have asked the questions: Is it safe? Is it effective? Is it caring? Is it responsive? We have then looked across the system to ask: Is it well led? Prior to visiting the local area we developed a local data profile containing analysis of a range of information available from national data collections as well as CQC s own data. We requested the local area to provide an overview of their health and social care system in a bespoke System Overview Information Request (SOIR) and asked a range of other local stakeholder organisations for information. Page 2

3 We also developed two online feedback tools: a relational audit to gather views on how relationships across the system were working, and an information flow tool to gather feedback on the flow of information when older people are discharged from secondary care services into adult social care. During our visit to the local area we sought feedback from a range of people involved in shaping and leading the system, those responsible for directly delivering care as well as people who use services, their families and carers. The people we spoke with included: Senior leaders and managers from Trafford Council (the local authority), NHS Trafford Clinical Commissioning Group (the CCG), Manchester Health and Care Commissioning (MHCC), Manchester University NHS Foundation Trust (MFT previously Central Manchester NHS Foundation Trust and University Hospital South Manchester NHS Foundation Trust), Salford Royal NHS Foundation Trust (SRFT) and Pennine Care NHS Foundation Trust (PCFT) Health and social care professionals including social workers, GPs, discharge teams, therapists, nurses and commissioners Healthwatch Trafford and voluntary and community sector (VCS) representatives Representatives of health and social care providers People using services, their families and carers at the Carers Centre, Fiona Gardens and a dementia day centre run by Age UK. We also spoke with people in A&E, the discharge lounge and visits to intermediate care facilities We reviewed 20 care and treatment records and visited 11 services in the local area including acute hospitals, intermediate care facilities, care homes, domiciliary care providers, GP practices, extra care housing, the Urgent Care Centre, out-of-hours GP and the Trafford Coordination Centre. Page 3

4 The Trafford context Demographics 16% of the population is aged 65 and over. 86% of the population is categorised as White. Trafford is in the 20-40% least deprived local authorities in England. Adult Social Care 42 active residential care homes: 23 rated Good 13 rated Requires improvement 2 rated Inadequate 4 currently unrated 21 active nursing care homes: 9 rated Good 10 rated Requires improvement INSERT INFOGRAPHIC 2 currently unrated 36 active domiciliary care agencies: 16 rated Good 13 rated Requires improvement 7 currently unrated Acute and community Healthcare Hospital admissions (elective and non-elective) of people of all ages living in Trafford LA were almost entirely at the following NHS acute hospital trusts: Central Manchester University Hospitals NHS Foundation Trust (RW3) Received 46% of admissions of people living in Trafford LA Admissions from Trafford made up 18% of the trust s total admission activity Rated Good overall. The second main trust is University Hospital of South Manchester NHS Foundation Trust (RM2) Received 45% of admissions of people living in Trafford LA Admissions from Trafford made up 29% of the trust s total admission activity Rated Requirement improvement overall. GP Practices 32 active locations 2 rated Outstanding 28 rated Good 1 rated Requires improvement 1 currently unrated These two trusts have recently merged to create Manchester University NHS Foundation Trust (R0A). Community services are provided by: Pennine Care NHS Foundation Trust (RT2) - currently rated Requires improvement overall All location ratings as at 29/09/2017. Admissions percentages from 2015/16 Hospital Episode Statistics. Map 1: Population of Trafford shaded by proportion aged 65+ and location Page of 4 services provided by the main acute trust for Trafford (R0A). Due to the recent merger, locations under this new trust are listed as Unrated. Community locations provided by RT2 aren t mapped as they cover a larger geographic area. Map 2: Location of Trafford LA within Greater Manchester STP. Trafford CCG is also highlighted.

5 Summary of findings Is there a clear shared and agreed purpose, vision and strategy for health and social care? There was system-wide commitment to serve the people of Trafford well. Trafford was on a journey of transformation and integration to achieve the strategic vision. The CCG and local authority were due to become fully integrated as commissioners by 1 April 2018 and there were governance structures in place to facilitate this transformation. The New Health Deal (NHD) for Trafford in 2012 was a programme of transformation of out- of-hospital services to ensure future viability. This incorporated the redesign of Trafford General Hospital (TGH) from an A&E site to a nurse-led urgent care centre and minor injuries unit, as well a site for day case surgery, some specialist elective procedures and an older person medical assessment unit. The context of Greater Manchester (GM) and the devolution of power provides a unique opportunity to transform the health and social care landscape. The Greater Manchester Health and Social Care Partnership is the vehicle for transformation across the GM-wide health and care system. The GM Taking Charge Implementation and Delivery Plan, set out a compelling and powerful vision for the future of health and social care services. This vision clearly set out what it would deliver for the people of Greater Manchester, and its localities including Trafford. Secondary care was also in transformation with recent hospital mergers and the vision for a single hospital service provided the opportunity for change. There was a clear line of communication and accountability from the Greater Manchester Health and Social Care Plan to Trafford. The Trafford Locality Plan and associated Transformation Bid (the Trafford case for transformation and associated transformation funding) were aligned to the priorities and strategic objectives of the wider conurbation, but were specific to the Trafford area, informed by the Trafford Joint Strategic Needs Assessment (JSNA). The Transformation Bid from Trafford set out the vision for a new model of integrated community care, mental health services, primary care and social care services to underpin the establishment of a Local Care Organisation (LCO), which would come into shadow form in April Trafford was earlier on in its journey compared to some other areas in Greater Manchester and system leaders should take the opportunity to see how contractual arrangements are being developed with other LCOs in GM. Page 5

6 Is there a clear framework for interagency collaboration? Historical relationships had been challenging across the system and there had been a significant amount of change among system leaders. Relationships were now improving and system leaders described the transformation agenda as the opportunity and accelerator for addressing systemic challenges and cultural issues. There was a shared understanding of the challenges, and a willingness to work together to achieve solutions. Manchester Health and Care Commissioning (MHCC) was the agreed GM lead commissioner for acute care, but Trafford system leaders felt their voice was heard in the wider system, despite their relatively smaller purchasing power. To maintain influence, Trafford should continue to ensure that their relationships with secondary care providers remain collaborative and effective. This is critical for improvements to be realised across the system. A section 75 agreement had been in place between the local authority and Pennine Care NHS Foundation Trust since 1 April 2016 to provide all-age health and social care community services. Joint commissioning arrangements existed between the CCG and local authority with regards to the voluntary sector, Ascot House (intermediate care facility) and children s community services and they had developed joint working principles ahead of the planned merger when they would form a single commissioning function. There was evidence of some risk sharing between partners. For example, the CCG and the local authority had proceeded at risk to implement some of the proposals outlined in the Transformation Bid. However, commissioning was collaborative rather than joint and the system needs to push forward with the transformation agenda through joint commissioning. How are interagency processes delivered? The challenge for this system was to transform services while also delivering improvements to ensure people were cared for in the right place, at the right time, by the right person. While there had been some significant improvements in performance over the past year, it was from a low base and the system s ability to cope with periods of surge in demand was uncertain. Governance structures were aligned to the Greater Manchester model and supported partnership working. A high level of scrutiny and challenge was provided by the Greater Manchester assurance process, but the role of Trafford s Health and Wellbeing Board and Scrutiny Board (the health overview scrutiny committee) needs to be strengthened. There was interagency collaboration at a high level, but frontline delivery of services was Page 6

7 still siloed. There was a complex service landscape and much of the High Impact Change agenda needed to be implemented, including seven day services and the use of trusted assessors. Strict admission criteria meant Ascot House was not working at capacity and some work was required to engage staff, provide clarity about the purpose of the service and encourage appropriate referrals. There were mechanisms in place to consult with wider system partners, including providers and voluntary sector organisations. However, the extent to which they felt like partners varied and there were missed opportunities to include and maximise providers contributions. What are the experiences of front line staff? System leaders and senior managerial staff were visible, engaged and had an overview of system performance. However, staff were not always clear who held the overall responsibility performance at a system level. Escalation channels were organisation-based and although issues were being escalated, there was mixed feedback from staff on whether this led to change. The degree to which frontline staff could articulate the system s vision varied and was often in the context of their own role rather than the wider system. There was a perception that staff were working to competing priorities, often dictated by sector-specific budgets and targets. There was a lack of trust across the health and social care interfaces, which was a legacy of historical cultural issues within the system. Front-line staff were committed to providing high quality, person-centred care. We saw some good examples of multi-disciplinary working. However, the system was multi-faceted and not yet working operationally in an integrated way across the health and social care interface. The capacity of individual teams was not always sufficient to keep up with demand. Staff reported there were multiple and confusing points to navigate the system and they did not always know who they could contact or which services they could refer into. There was limited evidence to date to demonstrate the effectiveness of the Trafford Co-ordination Centre (TCC). The TCC aimed to provide a single patient register of those identified most at risk to remotely co-ordinate their care and keep them well in the community by anticipating any interventions required. What are the experiences of people receiving services? The experience of people receiving health and social care in Trafford was varied. Page 7

8 If a person received a reablement service they achieved positive outcomes and were more likely to remain independent and at home. There were effective arrangements in place to provide equipment to people swiftly and community-based therapy services were responsive to referrals. However, there were also missed opportunities to support people to stay in their usual place of residence and prevent admissions to hospital. Primary care provision and GP access varied across the borough and information and support was not always easily accessible. In the first quarter of 2016, A&E attendances and emergency admissions from care homes were higher than average. A recent data refresh showed that emergency admissions from care homes had moved to being lower than comparator areas and the England average. However, the actual numbers of admissions from care homes were as high as they were the previous year and an increase in national averages overall had reduced the gap. People were being admitted with conditions that potentially could be cared for in the community, such as urinary tract infections. If a person went into crisis, data showed they were likely to be admitted to hospital and experience longer lengths of stay due to a shortage of homecare packages and affordable, high-quality residential and domiciliary care. The implementation of the personalisation agenda was underdeveloped. Very few people were in receipt of direct payments or personal health budgets and while there were innovation sites using the three conversations model, commissioning and contractual arrangements were traditional with a time and task focus. Providers and people who used services were extremely negative about the continuing healthcare (CHC) process in Trafford in terms of the assessment process and timely provision. There had been an injection of resource into the CHC team and data showed there had been some significant improvements to performance in recent months. Work was required to improve relationships and the negative perceptions. Are services in Trafford well led? Is there a shared clear vision and credible strategy which is understood across health and social care interface to deliver high quality care and support? As part of this review we looked at the strategic approach to delivery of care across the interface of health and social care. This included strategic alignment across the system, joint working, multi- Page 8

9 agency and multidisciplinary working and the involvement of people who use services, their families and carers. There was a shared clear vision and credible strategy for Trafford, which was aligned to the overarching vision for Greater Manchester. This was well articulated by leaders and there was a real commitment across system partners to deliver together; integration was the vehicle to achieve this. Historically there had been some challenging relationships, but these were improving. Staff at all levels were committed to achieving better outcomes, centred around the person and although there was a will to work more collaboratively they were frustrated by the number of barriers in the way. There were some missed opportunities to involve wider system partners in joint delivery plans, specifically around winter pressures which could have been addressed with a more cohesive, system-wide approach. There were pockets of integrated working arrangements already in in place. The strategic vision for Trafford included establishing a Local Care Organisation to provide the foundations of integrated provision, consistent with the GM-wide vision. These needed to be built upon and expanded at pace with a shift of focus to delivery. Strategy, vision and partnership working System leaders acknowledged that historically some relationships had been challenging, which had resulted in silo working, a culture of blame and a lack of shared responsibility in relation to performance. There had been some recent changes to senior personnel and organisational structures in the system. Relationships within Trafford and between statutory bodies were improving and integration was the vehicle to making the strategic vision a reality. However, we found varying progress in implementation of effective partnership working across different levels of the system. Leaders that we spoke to recognised there was work to be done to integrate delivery, through system transformation. The Greater Manchester Sustainability and Transformation Plan, Taking Charge Implementation and Delivery Plan set out a compelling and powerful vision for the future of health and social care provision and new models of care. Developed in partnership with 37 NHS organisations and local authorities, it clearly outlined what it hoped to deliver for the people of Greater Manchester. The GM STP was rated category 2 advanced in the July STP progress dashboard. A key deliverable of the Greater Manchester Plan was the development of a single hospital service which saw the merger of Central Manchester NHS Foundation Trust and University Hospital South Manchester NHS Foundation Trust to form Manchester University NHS Foundation Trust on 1 October There was universal support for this change from the Page 9

10 senior staff, voluntary sector organisations and providers we spoke with in the hope it would improve performance and consistency in people s experiences. There was a clear line of sight between the Greater Manchester STP, set out in the Taking Charge Implementation and Delivery Plan, and Trafford s vision and strategy, set out in the Trafford Locality Plan and Transformation Bid, which was well understood and articulated by system leaders. These outlined the approach to providing integrated, co-commissioned services with a place-based and community-asset focus to deliver on the vision of A sustainable health and social care system which aims to help older people be healthy, independent and enjoy living in Trafford. The strategic vision for Trafford focused on prevention and early intervention, outlining proposals for new models of community care, underpinned by the Local Care Organisation which would be coming into shadow form in April A section 75 Partnership Agreement had been in place between the local authority and PCFT since 1 April 2016 to provide community services via integrated health and social care teams within each of Trafford s four localities. Feedback from front line staff and senior leaders about this service delivery model was positive. Leaders described how the partnership agreement had led to effective working relationships with high levels of trust and thought it was something to be replicated across the system. Partners had agreed and signed of a joint plan for the Better Care Fund (BCF) within the deadline and the Improved Better Care Fund (ibcf) submission for Trafford was aligned with the Transformation Bid. System partners were working together to begin to implement the changes in the High Impact Change Model, one of the national conditions for the BCF. The rate of delayed transfers of care had started to improve, but much more needed to be done. Commissioners told us they were modelling future commissioning arrangements around the High Impact Change Model, but the extent to which this had been achieved was limited. For example, trusted assessors were being piloted in pockets, but not used widely. Some discharge to assess beds had been established, but seven day services were not operating across the system. There was awareness among system leaders of the shared challenge to reduce the causes of delayed transfer of care (DTOC). Data showed the whole system had made improvements to the length of stay and number of DTOC, but the latter remained considerably higher than average. At the time of our review there were 11 empty beds at Ascot House (an intermediate care facility), but on 16 October 2017 there were 39 people at Trafford General Hospital waiting to be discharged. Ascot House had dedicated GP input for approximately five hours a day, yet the service was supposed to be for medically Page 10

11 optimised people. We were advised that a review of the admission criteria was underway, but this should be concluded as a matter of urgency to ensure that services across the system are being used effectively and that people are being cared for in the most appropriate facility for their needs. A review was carried out by the Emergency Care Improvement Programme in This is a clinically led programme provided by NHS Improvement to provide practical advice and support to improve patient care and flow. As a result, a Head of Patient Flow had recently been appointed at Wythenshawe Hospital. A Community Flow Manager was due to begin work in November Although there was a clear ambition, there lacked a robust, system-wide response to the contributing factors to DTOC, such as managing capacity issues in the Homecare market. People from across the system told us issues were not being tackled with sufficient urgency to prevent a potential crisis. Trafford s plan for winter was presented and signed off at the Greater Manchester Urgent Care Board during the week of our review. The Trafford plan was aligned to Manchester s and had been developed jointly due to shared resilience plans around acute care. However, there was some confusion evident at strategic and operational level relating to the status of the plan. Some groups reported they had only recently been asked for their input, some had been asked to submit their organisation-level plans and others reported they had not been involved at all. Some system partners felt the plan was late, had not been adequately stress tested and was not a systematic approach. The system reported that they worked collaboratively with providers, housing partners and voluntary sector organisations. They had commissioned Healthwatch Trafford to undertake a system-wide review of intermediate care and were in discussions with extra care housing providers regarding winter capacity. While there were structures in place to facilitate engagement, there was not a single, coherent approach to working with other partners. Providers and VCS organisations felt the system was well-meaning, but some felt their input was a tick-box exercise and there was a top-down approach to issues such as winter planning and managing delayed transfers of care. Commissioners told us they recognised the potential of VCS organisations in preventative work and the need to learn from previous years and engage with them earlier on, in a more flexible way. However, the plan for winter had already been signed off by the Urgent Care Board, while a meeting with the voluntary sector to discuss winter resilience was planned, but had not yet taken place. Involvement of people who use services, their families and carers in the development of strategy and services Page 11

12 The Trafford Partnership, chaired by the leader of Trafford Council, brought together organisations across the public, private, voluntary, faith and community sector and local residents and was the system s Local Strategic Partnership to deliver on the One Trafford vision which aims to make Trafford a place where residents achieve their aspirations and communities thrive. There was a clear line of communication and accountability to Greater Manchester through Trafford s governance structures and Health and Wellbeing Board. The response to the System Overview Information Request (SOIR) described the approach to public engagement to ensure commissioning and service planning was based on the needs of Trafford residents. The local authority s approach was underpinned by a strategy, Building Strong Communities and the Trafford Partnership. Engagement approaches varied from targeted events to help shape the Care at Home vision and commissioning priorities, Locality Partnership Events to empower communities through funding and support; to engagement of the VCS via an umbrella organisation. Thrive Trafford had been commissioned by the local authority to establish a voluntary/ community/social enterprise (VCSE) strategic forum to bring together VCS providers, commissioners and other public service representatives to discuss issues including health and social care integration and isolation of older people. Positive outputs from these events have included a social isolation project delivered by the fire service and health walks from GP practices. System leaders were committed to involving service users, carers and their families in the strategic approach and a series of public and partner engagement events had been held in relation to the Transformation Bid. However, it was acknowledged that more targeted engagement was needed going forward to ensure service design proposals were coproduced. While there were mechanisms in place to obtain feedback from people, these were often focused at service or provider level rather than capturing their experience of the entire pathway. We received mixed feedback from some VCSE providers on how valued they felt as system partners in the planning and delivery of services, including planning for winter pressures. They felt underutilised by the system and that they had a lot to offer in relation to keeping people well at home. The VCSE organisations reported there used to be regular meetings with the local authority, but these had become fragmented. Concerns were also raised about the tender process and a lack of transparency around funding decisions following several short-notice contract terminations two years ago. Following our review, the system told us these contracts had not been part of the delayed transfer of care agenda and were a historic procurement issue. The local authority led joint commissioning arrangements with the CCG, including the Carer s Centre and children s community services. Page 12

13 It was recognised by the partnerships team at the local authority that there was a need to bring together health and social care contracts. We were told some 2017/18 VCSE winter resilience scheme monies were being used to work with VCSE organisations to develop innovative ideas. Promoting a culture of inter-agency and multi-disciplinary working The Trafford Locality Plan, Transformation Bid and existing section 75 agreement between the local authority and community care provider PCFT, provided the foundations for interagency and multi-disciplinary working. The local authority and the CCG will be fully integrated commissioners by April 2018 and there were joint working principles already in place. We found some positive examples of staff working in an integrated way to commission and deliver services. All staff we spoke with during the week of our review expressed a will to work more collaboratively and although we saw some examples of staff working in an integrated way, these were often dependent on individual relationships and not always facilitated by the system. Frontline staff were frustrated by the barriers to inter-agency working. These included technological barriers, a lack of clarity about services available, duplication of efforts and a lack of trust or competing priorities between organisations. Frontline staff were highly focused on delivering high-quality care, focused on the needs of the person. Our analysis of 2015/16 Hospital Episodes Statistics (HES) data showed prior to the creation of Manchester University NHS Foundation Trust, 45.7% of admissions of people of all ages from Trafford went to Central Manchester NHS Foundation Trust (CMFT), 45.1% went to University Hospital of South Manchester (UHSM) and 6.9% went to Salford Royal NHS Foundation Trust. Additional information supplied by the system indicated that UHSM received a greater proportion of admissions of Trafford s older population. Admissions from Trafford made up 18% of CMFT s admission activity and 29% of UHSM s, so the system s purchasing power was less than others particularly as they did not commission services directly. Learning and improvement across the system There were a variety of forums where quality and performance were monitored and discussed, but more evaluation and sharing of lessons learned across the system was needed. At the time of our review there were multiple pilots and concept testing programmes underway prior to system-wide roll-outs. Learning from these pilots was Page 13

14 shared with system leaders to demonstrate the impact they were having, but it was not systematically being cascaded to reach wider system partners or frontline staff at this stage. The system needs to work at pace to collate and implement the learning to drive improvement. Across the system, newsletters were used to share learning and feedback with staff. However these were for organisational news and there was not a system-wide mechanism for cascading messages to incorporate all partners. For example, staff reported they did not always receive feedback on incidents raised or whether there were common themes identified through safeguarding investigations. Social care providers reported there had historically been forums where they could feedback to the local authority, but all that existed currently were contract monitoring meetings. Following our review, the local authority told us there were fora available to providers, namely service improvements partnerships. Work was required to ensure these were well-known among commissioned services. There were plans in place to develop a Greater Manchester provider forum, but this had not been established at the time of our review. There were missed opportunities to ensure there was system-wide learning and improvement. The system could benefit from making sure there are opportunities to come together and discuss challenges, evaluate the effectiveness of initiatives and generate shared solutions. What impact is governance of the health and social care interface having on quality of care across the system? We looked at the governance arrangements within the system, focusing on collaborative governance, information governance and effective risk sharing. Providers and commissioners across the health and social care interface had governance systems and processes in place to assess, monitor and mitigate risks. There were three levels of governance to support the planning and delivery of integrated care, reporting upwards from the local system to Greater Manchester Health and Social Care Partnership Governance structures within the Trafford system and with Manchester Health Care Commissioning were aligned with those of Greater Manchester and provided a mechanism to ensure consistency in performance monitoring. System leaders felt the level of assurance required at both Greater Manchester and national levels was burdensome at times, but this was outweighed by the benefits of a shared Page 14

15 endeavour. Data and intelligence monitoring was shared across the system and reviewed daily at a senior level, but there needed to be more evaluation to drive improvements at pace. The Chairs of the Health and Wellbeing Board and of the Scrutiny Board acknowledged that the challenge functions of these bodies were not being used effectively. While risks were being escalated at every level, it was not always clear who held overall accountability for them. Overarching governance arrangements There were three levels of governance to support the planning and delivery of integrated care: the local level locally commissioned services and BCF governed through local commissioning accountabilities, HWBB and CCG, and through local providers; the wider system level (e.g. urgent care delivery board joint with Manchester, and Manchester Health and Social Care Commissioning as lead commissioner for acute care; and the Greater Manchester level through the Health and Social Care Partnership Board (HSCPB) and Joint Commissioning Board. Governance structures within Trafford mirrored those across Greater Manchester with local representation on the GM Health and Social Care Partnership Boards and there was a clear line of communication and accountability between the two, with vertical and horizontal reporting structures. Trafford s Integration Board, Joint Commissioning Board and Urgent Care Board worked alongside each other and reported to the local authority s executive boards as well as through to GM assurance structures. Although the level of assurance submitted to the GM HSCPB felt burdensome at times, this was outweighed by the benefits. System leaders felt the collaboration and supportive network facilitated by GM provided a unique, innovative accelerator for change. Trafford system partners need to continue to ensure their voice in the partnership; that the priorities set by GM remain relevant to the Trafford local area and that support is drawn from other areas where local challenges are identified. The Trafford Urgent Care Board provided the practical arrangements to deliver the vision for integrated health and social care pathways relevant to urgent care across Manchester and Trafford and set out strategic aims via a jointly developed and agreed project plan, providing oversight for implementation progress. This was attended by key system partners. Page 15

16 There was a transparent approach to sharing of management information across the health and social care interface. There were some agreed performance metrics set by GM in relation to flow and performance dashboards were in place. However, there were no integrated metrics between health and social care and monitoring was based on traditional performance indicators. We were told that work was underway to develop system-wide universal outcome measures. SRFT had developed a set of agreed, integrated metrics and Trafford could look to wider partners to see if these could be replicated within their system. Local authority leaders were visible and engaged. They were aware of the challenges faced by the system and were sighted on performance, but some were relatively new in post. Leaders reported positive working relationships despite political tensions in the past and there was a shared vision for the future. Although there was a significant amount of monitoring and measuring, there needs to be more evaluation. The Scrutiny Board s challenge function was underutilised; the Chair told us they were given verbal assurances by system leaders that performance was improving and pilots were producing positive outcomes, but there was a lack of data to evidence it. The Health and Wellbeing Board Chair had taken up the post two months prior to our review. There was an acknowledgement the Health and Wellbeing Board would benefit from a strengthening of its oversight and challenge function in relation to the transformation agenda. Work was already underway at the time of our review to facilitate this. Risk sharing across partners There was a shared view of risks across the system. These were managed in different forums depending on commissioning arrangements. For example, primary care performance was monitored by the CCG Governing Body and social care risks and quality performance were overseen by Joint Quality Monitoring meetings. There was little evidence of shared risk management outside of these arrangements. The Trafford system was early on in its journey to integration of health and social care. At all levels it was acknowledged there was some isolated working, but there was a will by system leaders to respond to risks collaboratively. Prior to the Transformation Bid being approved, the CCG and local authority had proceeded at risk to implement some elements of the proposed schemes to prevent delay. For example, increasing capacity of reablement services in the community. Staff at all levels had clarity about their roles and responsibilities, but this varied in relation Page 16

17 to inter-agency working. Staff were able to describe the governance structures in place to identify, record and escalate risks appropriately within their organisations. While system leaders were clear about their accountabilities, staff at other levels were not always aware of who was ultimately responsible for performance and risks at a system level. For example, in relation to DTOC or winter pressures. Information governance arrangements across the system The Trafford Locality Plan outlined the importance of adopting a universal approach to sharing information across health and social care to meet its strategic objectives and there were a number of information sharing agreements in place across the health and social care interface. The Trafford Co-ordination Centre (TCC), described by the system as air traffic control, aimed to provide a single patient register of those identified most at risk to remotely coordinate their care. The TCC had signed up all Trafford partners to an information sharing protocol to enable personal information to be moved through different agencies. However, at the time of our review not all partners could access the TCC clinical portal containing the shared patient data. This, coupled with the confusion around the role of the TCC and mixed feedback around its effectiveness, meant the benefits of a reciprocal information sharing arrangement were not being fully realised. Staff throughout the system reported that information sharing across the health and social care interface needed to improve and this was described as a key barrier to integrated working and improving outcomes for people. GPs and PCFT used the same electronic records system and the University Hospital of South Manchester site had permission to access GP records on a view-only basis, but this was not being put into practice by staff. We heard from GPs that a lack of access to primary care records by people working in the acute sector lead to people undergoing unnecessary diagnostic investigations, assessments and admissions. Eight of the of 15 Registered Managers of social care providers who responded to our survey in relation to information flows reported they received discharge summaries at least 75% of the time, but these were mostly in paper format and rarely electronic. Three respondents reported they rarely received discharge summaries. To what extent is the system working together to develop its health and social care workforce to meet the needs of its population? We looked at how the system is working together to develop its health and social care workforce, including the strategic direction and efficient use of the workforce resource. Page 17

18 There was a system-wide understanding of workforce capacity and future needs. Workforce strategies were aligned to that of Greater Manchester, however there was not one whole-system workforce strategy for Trafford; there were separate arrangements at commissioner level. While these were aligned in terms of strategic vision, the system needs to ensure that operational priorities are addressed through a fully integrated workforce strategy. There had been some efforts to address domiciliary care capacity issues, but with limited success to date. System level workforce planning There was not a system-level strategy for Trafford; Manchester, as lead commissioners, had developed a strategy for acute sector staff and Trafford CCG fed into the Greater Manchester workstream for acute workforce. The local authority and PCFT had developed a strategy for community health and social care, aligned to Greater Manchester, and had identified local workforce priorities: o o o Growing our own Developing and promoting our brand Developing our talent and a system wide approach to leadership The individual workforce plans were aligned with the strategic vision to move to multiprofessional, place-based and asset-focused models of care. However, as the Trafford Local Care Organisation comes into shadow form, system leaders should ensure priorities are complimentary to each other and succession planning is considered. There was a Greater Manchester workforce strategy overseen by the Health and Social Care Partnership Board, which outlined the workforce challenges and proposed GM wide solutions in the context of new models of care. Developing a skilled and sustainable workforce System leaders were working to develop and future-proof the workforce through partnerships at local and regional levels as well as with local further and higher education institutions. Workforce development was focused on growing our own, using apprenticeship levies, developing career paths and re-skilling and re-purposing existing teams. Some teams were already working in an integrated way in the four locality areas and pilots were being rolled out to empower staff at the frontline to make decisions. We heard from all system partners that competition with the retail sector and high educational attainment were key factors in recruiting domiciliary care staff. Analysis of Skills for Care workforce estimates for 2016/17 showed that the staff turnover rate in Page 18

19 Trafford was 35%, which was higher than the England average. However, 61% of new appointments were made to people who were already working in the social care sector in Trafford, which supported the view of providers who told us they were recruiting staff from the same pool as each other. Therefore, while employers were having to recruit to posts, the sector was retaining skills and experience. The local authority had tried several methods to increase workforce capacity, including recruitment days and a grow our own salaried, homecare workforce in the Partington area. The outputs from these initiatives had been minimal to date, so whilst the social care vacancy rate in Trafford was in line with the England average, it had increased since While all system leaders recognised domiciliary care capacity was a significant issue, there was not a system-wide response to addressing this issue. Is commissioning of care across the health and social care interface, demonstrating a whole system approach based on the needs of the local population? How do leaders ensure effective partnership and joint working across the system to plan and deliver services? We looked at the strategic approach to commissioning and how commissioners are providing a diverse and sustainable market in commissioning of health and social care services. Future commissioning strategies were aligned to the wider Greater Manchester STP Taking Charge Implementation and Delivery Plan and Trafford s locality plan, based on a needs assessment which took account of variation within the borough. Funding for transformation had just been approved and although some initiatives had been set up using ibcf monies and some partners taking shared risks, these had had limited success. Commissioners did not take a proactive approach and remained traditional and reactive to pressure points in the system, notably delayed transfers of care. Trafford faced significant market challenges which were widely accepted by system partners. However, responsibility for resolving them was not collective. There was scope for longer-term gains to the wider system if investment was made now to get a grip on the market. Strategic approach to commissioning The Trafford Locality Plan and Transformation Bid, involving the local authority, the CCG and acute care providers, set out the strategic approach to providing care within the four localities. This model was already being used by integrated community health and social care teams and some of the ibcf monies had been used to begin to implement some of the proposals. A needs assessment had been carried out for each of the localities to inform future commissioning plans and ensure local variation was considered. There were joint commissioning arrangements between the CCG and local authority with Page 19

20 regards to the voluntary sector, Ascot House (intermediate care facility) and children s community services. The two organisations were in the process of integrating to form a single commissioning function and a Joint Commissioning Board was already in place. Commissioning arrangements were collaborative rather than integrated at the time of the review, but a commissioning outcomes framework was being developed as part of the wider Greater Manchester devolution and staff were positive about future working arrangements. A strategic commissioning decision had led to putting a section 75 agreement in place between the local authority and Pennine Care NHS Foundation Trust (PCFT) since April 2016 in relation to community health and social care services. Commissioning support services to improve the interface between health and social care Future commissioning plans were focused on prevention, and on pathways and the person rather than services, which was positive. At the time of our review these were still to be implemented; commissioning was still separate and based on meeting national objectives and targets rather than taking a coherent system-wide approach. Data from March 2017 on provision of extended access to GPs outside of core contractual hours showed that only 3.2% of the 31 GP practices in Trafford surveyed offered full provision of extended access over the weekends and on weekday mornings or evenings compared to the England average of 22.5% and the average across Trafford s comparators of 23.8%. Weekend appointments were provided by the GP Federation on Saturdays and the out-ofhours provider on Sundays. However, if a person needed a face-to-face appointment out-ofhours when the walk-in centre and Urgent Care Centre were closed, they had to go to a site in Salford. Data available at the time of our review showed hospital admissions from care homes were higher than average. A recent data refresh showed that although there had been a reduction in the number of admissions, improvements were not sustained and care home providers reported that GP provision was variable. CCG staff advised plans were in place to enhance the level of support to care homes with a multi-disciplinary team model and up-skilling of nursing staff, but these had not been implemented at the time of our review. Although there were front door services commissioned to avoid hospital admissions, including the Older Persons Assessment and Liaison (OPAL) team, Community Enhanced Care (CEC) team, out-of-hours GP services and local pharmacies treating minor ailments; emergency admissions for over 65s in the first quarter of 2017 were higher at 75 per 1,000, compared to similar areas and the national average which were 69 and 64 per 1,000 respectively. The number of intermediate care beds had increased from five to 36 at Ascot House and the local authority had also commissioned nine discharge to assess beds at the same Page 20

21 facility. The response to the System Overview Information Request (SOIR) stated this increase in capacity had enabled the system to respond to seasonal fluctuations in activity and led to 30 delays in the summer of 2017 compared to 70 the year before. Published data showed there had been a reduction in DTOC across Trafford in recent months. While Ascot House could be used for step-up care, 90% of referrals were for step down care. In September 2017, the occupancy rate was 75% compared to a target of 85-90%. There was potential for this service to increase system-wide capacity and be utilised more effectively. An evaluation of the admission criteria had begun, but this needed to happen at pace and in collaboration with acute partners. Published data in relation to continuing healthcare (CHC) showed that Trafford CCG s performance in quarter one of 2017/18 was poor. High numbers of people were waiting longer than 28 days for their assessment and low numbers of people had been deemed eligible for Fast Track CHC (an indicator of end of life care performance). The response to the SOIR stated that the CCG had increased spending across CHC and Funded Nursing Care between 2013/14 and 2017/18 by approximately 5 million. There had been some changes to the CHC team and data provided by the system showed some positive improvements in performance; more people were receiving CHC funding, were being assessed quicker and not in an acute setting. Uptake of personal budgets was low at 5% and of 339 recipients of CHC, only 26 had a personal health budget or direct payment for all or part of their care. There were pilots ongoing with a focus around the three conversations model, which aims to replace traditional assessments for services with three conversations or questions, identifying what financial and social assets a person has and how they can be best supported to use them. While there were pilots ongoing around three conversations and building on assets in the community, there was no coherent plan to increase uptake of more personalised options for purchasing care and supporting the informal workforce. Current contracting arrangements were traditional and time and task focused. Voluntary sector organisations felt they were underutilised and there were concerns about the lack of provision for people with dementia. There were limited intermediate care facilities for people with dementia due to the admission criteria and while the local authority told us they commissioned dementia day care from Age UK on a spot-purchase basis, the provider told us they had not received any referrals since block funding was stopped by the local authority in July The cost of this service was prohibitive to many, often the most vulnerable groups. People we spoke with described some voluntary sector organisations as their life line, but finding out about the services available to support them was difficult. Market shaping Page 21

Manchester. Local system review report. Background and scope of the local system review. The review team. Health and Wellbeing Board

Manchester. Local system review report. Background and scope of the local system review. The review team. Health and Wellbeing Board Manchester Local system review report Health and Wellbeing Board Date of review: 16 20 October 2017 Background and scope of the local system review This review has been carried out following a request

More information

Health and wellbeing board Date of review: 4 8 September Background and scope of the local system review

Health and wellbeing board Date of review: 4 8 September Background and scope of the local system review Stoke-on-Trent Local system review report Health and wellbeing board Date of review: 4 8 September 2017 Background and scope of the local system review This review has been carried out following a request

More information

Plymouth. Local system review report. Background and scope of the local system review. The review team. Health and Wellbeing Board

Plymouth. Local system review report. Background and scope of the local system review. The review team. Health and Wellbeing Board Plymouth Local system review report Health and Wellbeing Board Date of review: 4-8 December 2017 Background and scope of the local system review This review has been carried out following a request from

More information

Halton. Local system review report Health and Wellbeing Board. Background and scope of the local system review. The review team

Halton. Local system review report Health and Wellbeing Board. Background and scope of the local system review. The review team Halton Local system review report Health and Wellbeing Board Date of review: 21-25 August 2017 Background and scope of the local system review This review has been carried out following a request from

More information

Oxfordshire. Local system review report. Background and scope of the local system review. The review team. Health and Wellbeing Board

Oxfordshire. Local system review report. Background and scope of the local system review. The review team. Health and Wellbeing Board Oxfordshire Local system review report Health and Wellbeing Board Date of review: 27 November to 1 December 2017 Background and scope of the local system review This review has been carried out following

More information

Local system reviews. Interim report

Local system reviews. Interim report Local system reviews Interim report December 2017 The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England. We make sure that health and social care services

More information

2017/ /19. Summary Operational Plan

2017/ /19. Summary Operational Plan 2017/18 2018/19 Summary Operational Plan Introduction This is the summary Operational Plan for Central Manchester University Hospitals NHS Foundation Trust (CMFT) for 2017/18 2018/19. It sets out how we

More information

NHS TRAFFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY 19 DECEMBER 2017

NHS TRAFFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY 19 DECEMBER 2017 Part 1 X Part 2 NHS TRAFFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY 19 DECEMBER 2017 Title of report Purpose of the report and key highlights Directorate Update - Nursing The report updates the Governing

More information

Manchester Health and Care Commissioning Board. A partnership between Manchester. City Council and NHS Manchester Clinical Commissioning Group

Manchester Health and Care Commissioning Board. A partnership between Manchester. City Council and NHS Manchester Clinical Commissioning Group Manchester Health and Care Commissioning Board A partnership between Manchester City Council and NHS Manchester Clinical Commissioning Group Agenda Item: Report Title: Date: Strategic Commissioning Prepared

More information

Responding to a risk or priority in an area 1. London Borough of Sutton

Responding to a risk or priority in an area 1. London Borough of Sutton Responding to a risk or priority in an area 1 London Borough of Sutton October 2017 Contents Contents... 2 Introduction... 3 Scope and activity... 4 What did we do?... 5 Framework... 6 Key findings...

More information

Please indicate: For Decision For Information For Discussion X Executive Summary Summary

Please indicate: For Decision For Information For Discussion X Executive Summary Summary Governing Body 22 March 2017 Details Part 1 X Part 2 Agenda Item No. 10 Title of Paper: Board Member: Author: Presenter: PAHT Quality Improvement Plan Catherine Jackson, Executive Nurse Catherine Jackson,

More information

Direct Commissioning Assurance Framework. England

Direct Commissioning Assurance Framework. England Direct Commissioning Assurance Framework England NHS England INFORMATION READER BOX Directorate Medical Operations Patients and Information Nursing Policy Commissioning Development Finance Human Resources

More information

Meeting in Common of the Boards of NHS England and NHS Improvement. 1. This paper updates the NHS England and NHS Improvement Boards on:

Meeting in Common of the Boards of NHS England and NHS Improvement. 1. This paper updates the NHS England and NHS Improvement Boards on: NHS Improvement and NHS England Meeting in Common of the Boards of NHS England and NHS Improvement Meeting Date: Thursday 24 May 2018 Agenda item: 03 Report by: Matthew Swindells, National Director: Operations

More information

Integrated Health and Care in Ipswich and East Suffolk and West Suffolk. Service Model Version 1.0

Integrated Health and Care in Ipswich and East Suffolk and West Suffolk. Service Model Version 1.0 Integrated Health and Care in Ipswich and East Suffolk and West Suffolk Service Model Version 1.0 This document describes an integrated health and care service model and system for Ipswich and East and

More information

Vision 3. The Strategy 6. Contracts 12. Governance and Reporting 12. Conclusion 14. BCCG 2020 Strategy 15

Vision 3. The Strategy 6. Contracts 12. Governance and Reporting 12. Conclusion 14. BCCG 2020 Strategy 15 Bedfordshire Clinical Commissioning Group Quality Strategy 2014-2016 Contents SECTION 1: Vision 3 1.1 Vision for Quality 3 1.2 What is Quality? 3 1.3 The NHS Outcomes Framework 3 1.4 Other National Drivers

More information

MEETING OF THE GOVERNING BODY IN PUBLIC 7 January 2014

MEETING OF THE GOVERNING BODY IN PUBLIC 7 January 2014 MEETING OF THE GOVERNING BODY IN PUBLIC 7 January 2014 Title: Bedfordshire and Milton Keynes Healthcare Review: The way forward Agenda Item: 4 From: Jane Meggitt, Director of Communications and Engagement

More information

SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATED JOINT BOARD UPDATE ON THE DRAFT COMMISSIONING & IMPLEMENTATION PLAN

SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATED JOINT BOARD UPDATE ON THE DRAFT COMMISSIONING & IMPLEMENTATION PLAN Appendix-2016-59 Borders NHS Board SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATED JOINT BOARD UPDATE ON THE DRAFT COMMISSIONING & IMPLEMENTATION PLAN Aim To bring to the Board s attention the Scottish

More information

Utilisation Management

Utilisation Management Utilisation Management The Utilisation Management team has developed a reputation over a number of years as an authentic and clinically credible support team assisting providers and commissioners in generating

More information

You said We did. Care Closer to home Acute and Community Care services. Commissioning Intentions Engagement for 2017/18

You said We did. Care Closer to home Acute and Community Care services. Commissioning Intentions Engagement for 2017/18 Commissioning Intentions Engagement for 2017/18 You said We did Care Closer to home Acute and Community Care services Top three priorities were: Shifting hospital services into the community Community

More information

Welcome. PPG Conference North and South Norfolk CCGs June 14 th 2018

Welcome. PPG Conference North and South Norfolk CCGs June 14 th 2018 Welcome PPG Conference North and South Norfolk CCGs June 14 th 2018 Housekeeping Packed Agenda! Quick feedback on the national patient participation conference Primary care general update and importance

More information

INTEGRATION TRANSFORMATION FUND

INTEGRATION TRANSFORMATION FUND MEETING DATE: 12 December 2013 AGENDA ITEM NUMBER: Item 6.6 AUTHOR: JOB TITLE: DEPARTMENT: Caroline Briggs Director of Commissioning NHS North Lincolnshire Clinical Commissioning Group REPORT TO THE CLINICAL

More information

NHS Bradford Districts CCG Commissioning Intentions 2016/17

NHS Bradford Districts CCG Commissioning Intentions 2016/17 NHS Bradford Districts CCG Commissioning Intentions 2016/17 Introduction This document sets out the high level commissioning intentions of NHS Bradford Districts Clinical Commissioning Group (BDCCG) for

More information

Responding to a risk or priority in an area 1. Partnership working to deliver health and social care in Cornwall

Responding to a risk or priority in an area 1. Partnership working to deliver health and social care in Cornwall Responding to a risk or priority in an area 1 Partnership working to deliver health and social care in Cornwall October 2017 Contents Introduction... 3 Scope and activity... 4 Framework... 5 Key findings...

More information

NHS ENGLAND BOARD PAPER

NHS ENGLAND BOARD PAPER NHS ENGLAND BOARD PAPER Paper: PB.28.09.2017/07 Title: Update on Winter resilience preparation 2017/18 Lead Director: Matthew Swindells, National Director: Operations and Information Purpose of Paper:

More information

Main body of report Integrating health and care services in Norfolk and Waveney

Main body of report Integrating health and care services in Norfolk and Waveney Item 18.73a ii Norfolk and Waveney Sustainability and Transformation Plan Update for governing bodies and trust boards September 2018 Purpose of report The purpose of this paper is to update members of

More information

Date of publication:june Date of inspection visit:18 March 2014

Date of publication:june Date of inspection visit:18 March 2014 Jubilee House Quality Report Medina Road, Portsmouth PO63NH Tel: 02392324034 Date of publication:june 2014 www.solent.nhs.uk Date of inspection visit:18 March 2014 This report describes our judgement of

More information

SWLCC Update. Update December 2015

SWLCC Update. Update December 2015 SWLCC Update Update December 2015 Croydon, Kingston, Merton, Richmond, Sutton and Wandsworth NHS Clinical Commissioning Groups and NHS England Working together to improve the quality of care in South West

More information

Merton Integration & Better Care Fund Plan 2017/19

Merton Integration & Better Care Fund Plan 2017/19 Merton Better Care Fund Programme Merton Clinical Commissioning Group Merton Integration & Better Care Fund Plan 2017/19 Area London Constituent Health and Wellbeing Boards Merton Constituent CCGs Merton

More information

Bury Health and Wellbeing Board. Annual Report for 2016/17

Bury Health and Wellbeing Board. Annual Report for 2016/17 Bury Health and Wellbeing Board Annual Report for 2016/17 Bury Health and Wellbeing Board Annual Report for 2016-17 Contents 1. Introduction... 3 2. Background to the Health and Wellbeing Board... 5 3.

More information

Driving and Supporting Improvement in Primary Care

Driving and Supporting Improvement in Primary Care Driving and Supporting Improvement in Primary Care 2016 2020 www.healthcareimprovementscotland.org Healthcare Improvement Scotland 2016 First published December 2016 The publication is copyright to Healthcare

More information

Melanie Craig NHS Great Yarmouth and Waveney CCG Chief Officer. Rebecca Driver, STP Communications and Jane Harper-Smith, STP Programme Director

Melanie Craig NHS Great Yarmouth and Waveney CCG Chief Officer. Rebecca Driver, STP Communications and Jane Harper-Smith, STP Programme Director Agenda Item: 9 Governing Body Thursday 25 January 2018 Subject: Presented By: Prepared By: Submitted To: Purpose of Paper: Norfolk and Waveney Sustainability and Transformation Partnership Update Melanie

More information

Our Health & Care Strategy

Our Health & Care Strategy MO Our Health & Care Strategy 2015-2020 Norfolk Community Health and Care NHS Trust Final September 2015 Version control Date Changes 1 19 th July 2015 Initial document 2 29 th July 2015 Following feedback

More information

BETTER CARE FUND 2016/17

BETTER CARE FUND 2016/17 BETTER CARE FUND 2016/17 NHS Dorset CCG Dorset County Council Bournemouth Borough Council Borough of Poole Final 03 05 16 The Systems Leadership Team (SLT) in Dorset is working towards integrating health

More information

Services for older people in South Lanarkshire

Services for older people in South Lanarkshire Services for older people in South Lanarkshire June 2016 Report of a joint inspection of adult health and social care services June 2016 Report of a joint inspection The Care Inspectorate is the official

More information

DRAFT. Primary Care Networks Reference Guide: Draft pre-release

DRAFT. Primary Care Networks Reference Guide: Draft pre-release Primary Care Networks Reference Guide: Draft pre-release This draft reference guide has been developed with input from a range of stakeholders to provide further information and guidance on what we mean

More information

Delivering Local Health Care

Delivering Local Health Care Delivering Local Health Care Accelerating the pace of change Contents Joint foreword by the Minister for Health and Social Services and the Deputy Minister for Children and Social Services Foreword by

More information

CLINICAL STRATEGY IMPLEMENTATION - HEALTH IN YOUR HANDS

CLINICAL STRATEGY IMPLEMENTATION - HEALTH IN YOUR HANDS CLINICAL STRATEGY IMPLEMENTATION - HEALTH IN YOUR HANDS Background People across the UK are living longer and life expectancy in the Borders is the longest in Scotland. The fact of having an increasing

More information

Plans for urgent care in west Kent:

Plans for urgent care in west Kent: Plans for urgent care in west Kent: Introduction and background A summary of our draft strategy NHS West Kent Clinical Commissioning Group (CCG) is working to improve urgent care services and we would

More information

NHS and independent ambulance services

NHS and independent ambulance services How CQC regulates: NHS and independent ambulance services Provider handbook March 2015 The Care Quality Commission is the independent regulator of health and adult social care in England. Our purpose We

More information

Trafford Housing Trust Limited

Trafford Housing Trust Limited Trafford Housing Trust Limited Trafford Housing Trust Limited Inspection report Sale Point 126-150 Washway Road Sale Greater Manchester M33 6AG Tel: 01619680461 Website: www.traffordhousingtrust.co.uk

More information

NHS Trafford Clinical Commissioning Group (CCG) Annual General Meeting(AGM) 26th September

NHS Trafford Clinical Commissioning Group (CCG) Annual General Meeting(AGM) 26th September RIGHT CARE RIGHT TIME RIGHT PLACE NHS Trafford Clinical Commissioning Group (CCG) Annual General Meeting(AGM) 26th September 2017 Introduction Matt Colledge Chair Introduction Trafford Clinical Commissioning

More information

Emergency admissions to hospital: managing the demand

Emergency admissions to hospital: managing the demand Report by the Comptroller and Auditor General Department of Health Emergency admissions to hospital: managing the demand HC 739 SESSION 2013-14 31 OCTOBER 2013 4 Key facts Emergency admissions to hospital:

More information

Performance Evaluation Report Pembrokeshire County Council Social Services

Performance Evaluation Report Pembrokeshire County Council Social Services Performance Evaluation Report 2013 14 Pembrokeshire County Council Social Services October 2014 This report sets out the key areas of progress and areas for improvement in Pembrokeshire County Council

More information

04c. Clinical Standards included in the Strategic Outline Care part 1, published in December 216

04c. Clinical Standards included in the Strategic Outline Care part 1, published in December 216 0c Clinical s included in the Strategic Outline Care part, published in December 6 Clinical standards The following clinical standards were included in the Strategic Outline Case part (SOC), published

More information

Adult Social Care Assessment & care management In-house care services

Adult Social Care Assessment & care management In-house care services Adult Social Care Assessment & care management In-house care services Service Plan 2015/16 Date 19/03/15 Final Directorate: Education Health and Social Care 1. Introduction Policy Context The Adult Social

More information

Personalised Health and Care 2020: Next steps

Personalised Health and Care 2020: Next steps Personalised Health and Care 2020: Next steps Paul Rice PhD Head of Technology Strategy NHS England www.england.nhs.uk Better use of data and technology has the power to improve health, transforming

More information

Performance Evaluation Report Gwynedd Council Social Services

Performance Evaluation Report Gwynedd Council Social Services Performance Evaluation Report 2013 14 Gwynedd Council Social Services October 2014 This report sets out the key areas of progress and areas for improvement in Gwynedd Council Social Services for the year

More information

Brent Better Care Fund Plan BRENT COUNCIL AND NHS BRENT CCG (V1.0 FINAL)

Brent Better Care Fund Plan BRENT COUNCIL AND NHS BRENT CCG (V1.0 FINAL) Brent Better Care Fund Plan 2017-2019 BRENT COUNCIL AND NHS BRENT CCG (V1.0 FINAL) 0 Contents 1. Introduction... 2 2. Case for Change... 2 3. Brent s vision for health and care... 5 4. Better Care Fund

More information

Board Meeting. Oxfordshire Clinical Commissioning Group. Date of Meeting: 27 July 2017 Paper No: 17/55

Board Meeting. Oxfordshire Clinical Commissioning Group. Date of Meeting: 27 July 2017 Paper No: 17/55 Oxfordshire Clinical Commissioning Group Oxfordshire Clinical Commissioning Group Board Meeting Date of Meeting: 27 July 2017 Paper No: 17/55 Title of Paper: Improved Better Care Fund and the Pooled Budgets

More information

21 March NHS Providers ON THE DAY BRIEFING Page 1

21 March NHS Providers ON THE DAY BRIEFING Page 1 21 March 2018 NHS Providers ON THE DAY BRIEFING Page 1 2016-17 (Revised) 2017-18 (Revised) 2018-19 2019-20 (Indicative budget) 2020-21 (Indicative budget) Total revenue budget ( m) 106,528 110,002 114,269

More information

General Practice Commissioning Strategy Development

General Practice Commissioning Strategy Development General Practice Commissioning Strategy Development Katharine Denton (Wandsworth CCG) 3 December 2014 Version 5. 03.12.2014 1 1. Introduction Strong General Practice is at the heart of any high quality

More information

The Bedfordshire CCG and Bedford Borough Council Better Care Plan Executive Summary: Our approach to Better Care planning

The Bedfordshire CCG and Bedford Borough Council Better Care Plan Executive Summary: Our approach to Better Care planning DRAFT Version 16 19 March 2014 The Bedfordshire CCG and Bedford Borough Council Better Care Plan Executive Summary: Our approach to Better Care planning Bedford Borough and Bedfordshire CCG s Better Care

More information

CLINICAL AND CARE GOVERNANCE STRATEGY

CLINICAL AND CARE GOVERNANCE STRATEGY CLINICAL AND CARE GOVERNANCE STRATEGY Clinical and Care Governance is the corporate responsibility for the quality of care Date: April 2016 2020 Next Formal Review: April 2020 Draft version: April 2016

More information

Bedfordshire, Luton and Milton Keynes. Sustainability and Transformation Plan. Central Brief: February 2018

Bedfordshire, Luton and Milton Keynes. Sustainability and Transformation Plan. Central Brief: February 2018 Bedfordshire, Luton and Milton Keynes Sustainability and Transformation Plan Central Brief: February 2018 Issue date: February 2018 News Transforming care closer to home Our ambition is to build high quality,

More information

Joint framework: Commissioning and regulating together

Joint framework: Commissioning and regulating together With support from NHS Clinical Commissioners Regulation of General Practice Programme Board Joint framework: Commissioning and regulating together A practical guide for staff January 2018 Publications

More information

JOB DESCRIPTION. Joint Commissioning Manager for Older People s Residential Care and Nursing Homes

JOB DESCRIPTION. Joint Commissioning Manager for Older People s Residential Care and Nursing Homes JOB DESCRIPTION Job Title: Grade: Team: Accountable to: Joint Commissioning Manager for Older People s Residential Care and Nursing Homes HAY 14 / AfC 8b (indicative) Partnership Commissioning Team Head

More information

Shaping the best mental health care in Manchester

Shaping the best mental health care in Manchester Clinical Transformation Plans Manchester Shaping the best mental health care in Manchester Meeting the needs of our communities Improving Lives OUR SHARED WAY AHEAD... Clinical Service Transformation in

More information

Northumberland, Tyne and Wear, and North Durham Draft Sustainability and Transformation Plan A summary

Northumberland, Tyne and Wear, and North Durham Draft Sustainability and Transformation Plan A summary Northumberland, Tyne and Wear, and North Durham Draft Sustainability and Transformation Plan A summary This summary has been prepared to aid understanding of the draft STP technical submission. Copies

More information

South East Essex. Discharge to Assess Strategy

South East Essex. Discharge to Assess Strategy South East Essex Discharge to Assess Strategy 2018-2020 Version 3.5 27 th March 2018 Document Control: Revision: Name Date: Version 2.0 Shirley Regan 12 December 2017 Version 2.1 Amendments-Paul 19 December

More information

DRAFT BUSINESS PLAN AND CORPORATE OBJECTIVES 2017/8

DRAFT BUSINESS PLAN AND CORPORATE OBJECTIVES 2017/8 DRAFT BUSINESS PLAN AND CORPORATE OBJECTIVES 2017/8 West London Clinical Commissioning Group This document sets out a clear set of plans and priorities for 2017/18 reflecting West London CCGs ambition

More information

Tackling barriers to integration in Health and Social Care

Tackling barriers to integration in Health and Social Care Viewpoint 69 Tackling barriers to integration in Health and Social Care The drivers for greater integration of health and social care are wellknown: an increasing elderly population, higher demand for

More information

Mental Health Crisis Care: Essex Summary Report

Mental Health Crisis Care: Essex Summary Report Mental Health Crisis Care: Essex Summary Report Date of local area review: Onsite 16-17 December 2014 Date of publication: June 2015 This inspection was carried out under section 48 of the Health and Social

More information

1. Introduction. Cllr Maurice Jones Chair Central Bedfordshire Health and Wellbeing Board

1. Introduction. Cllr Maurice Jones Chair Central Bedfordshire Health and Wellbeing Board Contents: 1. Introduction 2. The Vision for Integrated Care 3. The Case for Change 4. BCF Plans 16/17 Delivery 5. Agreed approach to financial risk share and contingency 6. The National Conditions 7. BCF

More information

Update on co-commissioning of primary care: guidance for CCG member practices and LMCs

Update on co-commissioning of primary care: guidance for CCG member practices and LMCs Update on co-commissioning of primary care: guidance for CCG member practices and LMCs British Medical Association bma.org.uk This paper is an update of previous GPC (general practitioners committee) guidance

More information

Annual Review and Evaluation of Performance 2012/2013. Torfaen County Borough Council

Annual Review and Evaluation of Performance 2012/2013. Torfaen County Borough Council Annual Review and Evaluation of Performance 2012/2013 Local Authority Name: Torfaen County Borough Council This report sets out the key areas of progress in Torfaen Social Services Department for the year

More information

Improving General Practice for the People of West Cheshire

Improving General Practice for the People of West Cheshire Improving General Practice for the People of West Cheshire Huw Charles-Jones (GP Chair, West Cheshire Clinical Commissioning Group) INTRODUCTION There is a growing consensus that the current model of general

More information

Norfolk and Suffolk NHS Foundation Trust mental health services in Norfolk

Norfolk and Suffolk NHS Foundation Trust mental health services in Norfolk Norfolk Health Overview and Scrutiny Committee 7 December 2017 Item no 6 Norfolk and Suffolk NHS Foundation Trust mental health services in Norfolk Suggested approach by Maureen Orr, Democratic Support

More information

Strategy & Business Plan: Executive Summary

Strategy & Business Plan: Executive Summary Strategy & Business Plan: Executive Summary May 2016 Overview The 2016/17 Strategy and Business Plan puts Yorkshire and Humber Academic Health Science Network at the heart of the sustainability and transformation

More information

FIVE TESTS FOR THE NHS LONG-TERM PLAN

FIVE TESTS FOR THE NHS LONG-TERM PLAN Briefing 10 September 2018 FIVE TESTS FOR THE NHS LONG-TERM PLAN The new NHS long-term plan is a significant opportunity for the health service. It can set out a clear and achievable path for sustaining

More information

The Integrated Support and Assurance Process (ISAP): guidance on assuring novel and complex contracts

The Integrated Support and Assurance Process (ISAP): guidance on assuring novel and complex contracts The Integrated Support and Assurance Process (ISAP): guidance on assuring novel and complex contracts Part A: Introduction Published by NHS England and NHS Improvement August 2017 First published: Friday

More information

Norfolk and Waveney STP. Meeting with East Suffolk Partnership 27 September 2017

Norfolk and Waveney STP. Meeting with East Suffolk Partnership 27 September 2017 Norfolk and Waveney STP Meeting with East Suffolk Partnership 27 September 2017 2 The Norfolk and Waveney STP Members Waveney District Council Focus of Norfolk and Waveney STP Our plan is in line with

More information

Education and Training Interventions to Improve Patient Safety

Education and Training Interventions to Improve Patient Safety Health Education England Education and Training Interventions to Improve Patient Safety Health Education England Implementation Plan 2016 2018 Developing people for health and healthcare www.hee.nhs.uk

More information

GM Devolution. Darren Banks Executive Director of Strategy

GM Devolution. Darren Banks Executive Director of Strategy GM Devolution Darren Banks Executive Director of Strategy Ground to be covered Greater Manchester The Devolution Journey What we are doing and the governance Manchester s Locality Plan 2 Greater Manchester:

More information

Appendix 1: Integrated Urgent Care Service Update. 1. Purpose

Appendix 1: Integrated Urgent Care Service Update. 1. Purpose Appendix 1: Integrated Urgent Care Service Update 1. Purpose The purpose of this paper is to provide Governing Body members across the collaborative CCGs with an update on the progress of the Integrated

More information

Engagement Summary. North London Partners Urgent and Emergency Care Programme. Camden Barnet Enfield Haringey Islington

Engagement Summary. North London Partners Urgent and Emergency Care Programme. Camden Barnet Enfield Haringey Islington Engagement Summary North London Partners Urgent and Emergency Care Programme Camden Barnet Enfield Haringey Islington Introduction This report summarises a year-long programme of engagement undertaken

More information

NHS DORSET CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING ADULT AND CHILDREN CONTINUING HEALTHCARE ANNUAL REPORT

NHS DORSET CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING ADULT AND CHILDREN CONTINUING HEALTHCARE ANNUAL REPORT 9.6 NHS DORSET CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING ADULT AND CHILDREN CONTINUING HEALTHCARE ANNUAL REPORT Date of the meeting 18/07/2018 Author Sponsoring Board member Purpose of Report

More information

Homecare Support Support Service Care at Home 152a Lower Granton Road Edinburgh EH5 1EY

Homecare Support Support Service Care at Home 152a Lower Granton Road Edinburgh EH5 1EY Homecare Support Support Service Care at Home 152a Lower Granton Road Edinburgh EH5 1EY Type of inspection: Unannounced Inspection completed on: 19 December 2014 Contents Page No Summary 3 1 About the

More information

North West London Draft Sustainability and Transformation Plan Review

North West London Draft Sustainability and Transformation Plan Review North West London Draft Sustainability and Transformation Plan Review In carrying out our work and preparing our report, we have worked solely on the instructions of the West London Alliance (specifically

More information

Control: Lost in Translation Workshop Report Nov 07 Final

Control: Lost in Translation Workshop Report Nov 07 Final Workshop Report Reviewing the Role of the Discharge Liaison Nurse in Wales Document Information Cover Reference: Lost in Translation was the title of the workshop at which the review was undertaken and

More information

Mental health and crisis care. Background

Mental health and crisis care. Background briefing February 2014 Issue 270 Mental health and crisis care Key points The Concordat is a joint statement, written and agreed by its signatories, that describes what people experiencing a mental health

More information

London s Mental Health Discharge Top Tips. LONDON Urgent and Emergency Care Improvement Collaborative

London s Mental Health Discharge Top Tips. LONDON Urgent and Emergency Care Improvement Collaborative London s Mental Health Discharge Top Tips LONDON Urgent and Emergency Care Improvement Collaborative November 2017 1 Introduction These Top Tips commenced their journey at the Pan London Reducing delays

More information

NICE guideline Published: 22 September 2017 nice.org.uk/guidance/ng74

NICE guideline Published: 22 September 2017 nice.org.uk/guidance/ng74 Intermediate care including reablement NICE guideline Published: 22 September 2017 nice.org.uk/guidance/ng74 NICE 2017. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).

More information

QUALITY STRATEGY

QUALITY STRATEGY NHS Nene and NHS Corby Clinical Commissioning Groups QUALITY STRATEGY 2017-2021 Approved: By the Joint Quality Committee on 11 April 2017 Ratified: By the NHS Corby Clinical Commissioning Group on 25 April

More information

Marginal Rate Emergency Threshold. Executive Summary

Marginal Rate Emergency Threshold. Executive Summary Part 1 meeting of the Castle Point and Rochford CCG Governing Body held on 29 th September 2016 Agenda item 16 Marginal Rate Emergency Threshold Submitted by: Prepared by: Status: Robert Shaw, Joint Director

More information

WORKING FOR A HEALTHIER MANCHESTER

WORKING FOR A HEALTHIER MANCHESTER WORKING FOR A HEALTHIER MANCHESTER STAKEHOLDER BULLETIN EIGHT February 2018 1 CONTENTS Foreword Page 3 The future of health and social care: the next five years Page 4 Healthy Neighbourhoods Page 5 Community-based

More information

NHS Somerset CCG OFFICIAL. Overview of site and work

NHS Somerset CCG OFFICIAL. Overview of site and work NHS Somerset CCG Overview of site and work NHS Somerset CCG comprises 400 GPs (310 whole time equivalents) based in 72 practices and has responsibility for commissioning services for a dispersed rural

More information

Integrating Health & Social Care in Kirklees

Integrating Health & Social Care in Kirklees Integrating Health & Social Care in Kirklees The case for change DRAFT v3.1 June 2017 Integrated Commissioning - Building on Existing Approaches Some example Children s services Mental health Hospital

More information

Staffordshire and Stoke on Trent Partnership NHS Trust. Operational Plan

Staffordshire and Stoke on Trent Partnership NHS Trust. Operational Plan Staffordshire and Stoke on Trent Partnership NHS Trust Operational Plan 2016-17 Contents Introducing Staffordshire and Stoke on Trent Partnership NHS Trust... 3 The vision of the health and care system...

More information

The Welsh NHS Confederation s response to the inquiry into cross-border health arrangements between England and Wales.

The Welsh NHS Confederation s response to the inquiry into cross-border health arrangements between England and Wales. Welsh Affairs Committee. Purpose: The Welsh NHS Confederation s response to the inquiry into cross-border health arrangements between England and Wales. Contact: Nesta Lloyd Jones, Policy and Public Affairs

More information

TITLE OF REPORT: Looked After Children Annual Report

TITLE OF REPORT: Looked After Children Annual Report NHS BOLTON CLINICAL COMMISSIONING GROUP Public Board Meeting AGENDA ITEM NO: 13 Date of Meeting:..27 th October 2017.. TITLE OF REPORT: Looked After Children Annual Report 2016-2017 AUTHOR: Christine Dixon,

More information

2020 Objectives July 2016

2020 Objectives July 2016 ... 2020 Objectives July 2016 1 About NHS Improvement NHS Improvement is responsible for overseeing NHS foundation trusts, NHS trusts and independent providers. We offer the support these providers need

More information

Report to the Board of Directors 2016/17

Report to the Board of Directors 2016/17 Attachment 8 Report to the Board of Directors 2016/17 Date of meeting 30 September 2016 Subject Report of Prepared by Purpose of report Previously considered by (Committee/Date) Local A&E Delivery Board

More information

Shaping the future CQC s strategy for 2016 to 2021

Shaping the future CQC s strategy for 2016 to 2021 Shaping the future CQC s strategy for 2016 to 2021 CQC is the independent regulator of health and adult social care in England. We make sure health and social care services provide people with safe, effective,

More information

This will activate and empower people to become more confident to manage their own health.

This will activate and empower people to become more confident to manage their own health. Mid Nottinghamshire Self Care Strategy 2014-2019 Forward The Mid Nottinghamshire Self Care Strategy will be the vehicle which underpins our vision to deliver an increased understanding of and knowledge

More information

Reducing Variation in Primary Care Strategy

Reducing Variation in Primary Care Strategy Reducing Variation in Primary Care Strategy September 2014 Page 1 of 14 REDUCING VARIATION IN PRIMARY CARE STRATEGY 1. Introduction The Reducing Variation in Primary Care Strategy should be seen as one

More information

Discharge to Assess Standards for Greater Manchester

Discharge to Assess Standards for Greater Manchester Discharge to Assess Standards for Greater Manchester 1 Contents 1. Introduction... 3 2. Definition of Discharge to Assess... 3 3. Discharge to Assess Pathways... 4 4. Greater Manchester Standards for Discharge

More information

Strategic Plan for Fife ( )

Strategic Plan for Fife ( ) www.fifehealthandsocialcare.org Strategic Plan for Fife (2016-2019) Summary Document Supporting the people of Fife together Foreword NHS Fife and Fife Council are working together in a new Integrated Health

More information

PATIENT AND SERVICE USER EXPERIENCE STRATEGY

PATIENT AND SERVICE USER EXPERIENCE STRATEGY PATIENT AND SERVICE USER EXPERIENCE STRATEGY APRIL 2017 TO MARCH 2020 Date 24 March 2017 Version Final Version Previously considered by The Patient Experience Group version 0.1 draft The Executive Management

More information

Norfolk and Waveney STP - summary of key elements

Norfolk and Waveney STP - summary of key elements Our Vision Norfolk and Waveney STP - summary of key elements 1. We have agreed our vision: To support more people to live independently at home, especially the frail elderly and those with long term conditions.

More information

Delivering Integrated Health and Social Care for Older People with Complex Needs across Western Bay. Statement of Intent

Delivering Integrated Health and Social Care for Older People with Complex Needs across Western Bay. Statement of Intent Delivering Integrated Health and Social Care for Older People with Complex Needs across Western Bay Statement of Intent March 2014 1 1. Introduction This document sets out our commitment to deliver integrated

More information